Saturday, December 15, 2007

Monday, December 3, 2007

I know the words, "THANK YOU" from me now might seem like such a cliche, and you're probably all tired of hearing them from me......hehe.. BUT, that's exactly how I feel day after day. I continue to get words of encouragement from people all over the world who have grown to love Sunshade & Jaffa. We have also just started to receive our Christmas cards from the exchange, and they are all filled with words of comfort. So THANK YOU! I am so grateful to have all of you with me on this journey to make OUR Jaffaman the best he could possibly be health wise.

Jaffa is still feeling great with LOTS and LOTS and LOOOOOOTS of energy. Clinically, he shows no signs of being in renal failure. We won't be doing blood work for another few weeks (I'm thinking to wait until after X-mas....) so we have no idea how his kidneys are currently functioning. I will definitely keep you updated tho, so no worries!

A few people have asked me about the renal supportive supplements I've been giving Sunshade and Jaffa, and also about Jaffa's diet. So I will be posting what I've been giving Sunshade for the last five years that's kept her kidneys healthy, and what I'm doing with Jaffa now.

(Sunshade: I think she meant to say, the post gets boring from here on. Not that it was interesting to begin with, it wasn't about the perfectME.... Nothing is ever about the perfectME anymore....)

DIET:

Diet restriction only needs to be done when serum Creatinine & BUN are elevated. If done too early, you risk doing more harm than good. This is why even tho Sunshade has compromised kidneys (normal blood work), she has not been on a kidney diet.

There is a common misconception that "protein" is bad for compromised kidneys. The truth however, is not actually the protein that is damaging, but the nutrient "Phosphorous". Usually, foods high in protein contains higher amounts of phosphorous. Meat for example is a lot higher in phosphorous content than say vegetables. So you do, inadvertently end up limiting the amount of protein in take per day when trying to limit phosphorous content.

Keep in mind when formulating a kidney diet, you want to feed foods that are most bioavailable (little waste, easiest on kidneys), higher fat content (for extra calories), while keeping the Phosphorous content within the daily allowance. Cooked egg white is the PERFECT type of food for kidney dogs as it contains moderate amount of VERY high bioavailable protein, and is very low in phosphorous.

The daily allowance for dogs in mid-stage to late-stage renal failure is:

11-15 mg of phosphorous/per pound/per day.

According to Jaffa's last blood work, he is in very early stage of renal failure. However because his condition might be acute or reversible, we are treating him more aggressively than we normally would for a dog at his stage.

Jaffa should weigh around 60 lbs, so his diet is based on his daily allowance of 660-900 mg of phos per day.

I use a very useful site called NATS (Nutrition Analysis Tools and System) to formulate his diet.

Sample Kidney Diet for Jaffa (growing, high energy, large breed dog):

50 g Whole Milk Yogurt

1 Cup Cooked Glutinous Rice

1 Cup Cooked Butternut Squash

600 g Regular Ground Beef

4 Large Egg Whites

Once I punched all that in, I get the analysis for each individual food item: (click to enlarge)

I click again, and I get the combined analysis. This is what I'm more interested in because it tells me the total amount of Calories, Protein, Calcium, Phosphorous, etc the diet provides.

From the analysis, I can see that he gets 897.67 mg of Phos/day, which is within the allowance range. He is getting enough calories (Sunshade: waaaaaay tooooo muuuuuuch energy for land sharrrrrrrrrking!), and the protein he gets are in high bioavailable forms (raw meat, cooked egg whites). I divide the diet into three portions and feed him three times a day to make things easier on his kidneys.

I have dropped all raw bones from Jaffa's diet. As nutritious as raw bones are, they are also very high in phosphorous. The Calcium to Phosphorous ratio in the diet needs to be balanced or the body will pull calcium from bones/teeth to try to balance the serum Calcium. Because he is no longer getting calcium from bones, I am having to add a calcium supplement with every feeding.

Ca : Phos ratio in diet should be ~ 1.25 : 1

From the recipe, he is getting 897.67 mg of Phos, and 166.92 mg of Cal.

I multiply his Phos number by 1.25 to get how much Cal he should get to get the ratio:

897.67 mg X 1.25 = 1122.1 mg of Cal

Then I take the should get Cal amount (1122.1 mg) and minus the Cal already in the diet (166.92 mg) and I get how much Cal supplement I need to add.

1122.1 mg Cal - 166.92 mg Cal = 955.2 mg Cal to add

Since I'm dividing the recipe into three feedings, I divide 955.2 by three to get how much Cal supplement I need to add per feeding:

This is what I give Sunshade too instead of bones on days she gets red meat only. All the white meats Sunshade gets have bones ground in them.

I believe in feeding different varieties. So I alternate meat sources and also buy ground chicken/turkey without bones for him. Yes.... that means a different analysis with each item I changed since they all have different phosphorous contents.

I don't like all the carb he is getting, especially the glutinous rice, but they provide extra calories and are low in phosphorous. Basically used as fillers.... SIGH... gotta do whatever that's best for those kidneys tho..... at least for now.... (can you tell how much I dislike giving them grains?? LOL)

KIDNEY SUPPLEMENTS for Sunshade & Jaffa:

Here are the supplements Sunshade has been getting since I found out about her kidney insufficiency in 2003:

Vit-B complex, Vit-C

Both are water soluble vitamins. Kidney dogs pee a lot more, so those get leached out.

Fish body oil (highest EPA/DHA)

protect kidneys, and other body organs. The higher the content of long chain fatty acids EPA/DHA are the better. It is also great for Sunshade's arthritis.

Vit-E

Fat soluble vitamin. Given to slow down the oxidation process of the high dose fish oil given.

Hawthorne and Ginkgo are both to increase blood flow throughout the body. Increased circulation, better for the kidneys. Milk Thistle is detoxing liver. Sunshade usually goes on the tinctures for about two months, then she's off them for three months, and back on two and so on. The tinctures come in an alcohol base, so I pour boiling water over to evaporate the alcohol before giving.

CoQ-10 (Coenzyme Q10)

An antioxidant aiding heart health. However, studies have shown that it seems to reduce serum Creatinine reading in human kidney failure patients. It needs to be given in or with an oil base for it to be properly assimilated. Some products come in an oil based Q-Gel capsule,

I give a probiotic formula that contains a few specific strains of bacteria (Streptococcus thermophilis, Lactobacillus acidophilus, and Bifidobacterium longum) together with a capsule of psyllium husk (Metamucil).

The reason I give the above is based on Kibow Biotech's Enteric Dialysis - "the process by which colon-friendly, non-pathogenic microbes consume uremic toxins or metabolites."

Basically those probiotics work together with a prebiotic (psyllium husk) to form a nitrogen trap, and trap the excess uremic waste the compromised kidneys cannot process. Instead of going through the kidneys and being eliminate via urine, the uremic wastes are eliminated through the bowel. Hence reducing uremic toxins in blood.

If you have a small dog, you might consider buying the Kibow product. It is also being sold under a different name now - Azodyl.

Unfortunately, I can't afford $200 per month on one supplement for the two of them. So I found a probiotic formula which contains the strains I want and just give it together with a Metamucil capsule. I have no idea if I'm giving them at the right ratio for it to work the way the company's product works.... but Sunshade has been doing well so far.... knock wood.

Recommended for dogs in kidney failure to use as a phosphorous binder. It contains calcium carbonate and Chitosan. Company claims studies have shown Chitosan to be effective at lowering serum calcium.

1 scoop = 1 g = 100 mg calcium carbonate + 80 mg Chitosan

With Sunshade, she ever only got this when on days she got red meat only, no bones to balance out the phosphorous.

From what I've read on the K9KidneyDiet list, Epakitin should NOT be used if the serum Calcium is elevated. Also, it is NOT an effective phosphorous binder *if* the serum Phosphorous is elevated. An aluminum based phosphorous binder (ie, Amphogel) is required then. Some suggested buying Chitosan alone and give it on its own if it does indeed lower serum Creatinine reading.

Right now with Jaffa, I alternate Epakitin with pure calcium carbonate. Because his serum phosphorous level is normal, he does not need an aluminum based phosphate binder.

SUPPLEMENTS for Jaffa only:

Here are some supplements only Jaffa is taking because he needs all the help he can get right now. His liver was also effected, so he is on some liver supplements as well.

Jaffa gets 500 ml of Sub-Q fluids a day. I know some feel since he is in an acute stage, I should be treating him more aggressively with anywhere between 700 - 1300 ml of Sub-Q per day. However, the truth is, I can only get about 500 ml in him in one spot, and I really DON'T want to have to poke him twice a day with those HUGE needles. I'm not sure if you can tell how big that needle is beside a ball point pen..... but it scares me..

He has been so good, so co-operative with me poking and giving him fluids. The first time I poked him, he turned and gave me that "Why did you hurt me mummy?" look, and followed by a few kisses.... almost made me cry (but I didn't!). Then I told him to lie down and stay, and he fell asleep with his head on my lap. My Jaffaman!!

Here are a few pictures of Jaffa getting Sub-Q,

And some loving!! It takes about 15-20 mins to give him 500 ml.

Oh, and he looks like he's got a big growth on the side with all that fluid inside him.....

I do get at least another 500 ml of water/broth in him be it through mixing with food or syringe. (Sunshade: mum, are you gonna talk about ME?? How perfect I am??)

Ok ok, here is a little brag about the perfect Sunshade.. hehe. Since I found out about her kidneys back in 2003, I knew keeping her hydrated was very important. She never drank enough water (I felt), possibly due to the moisture from her raw diet. So I, of course, was worried.........

Hmmmm...... I trained the perfect Sunshade..... to um.... drink on command LOL. Yea... so everyday, I tell her to "GET WATER" and "FINISH IT UP" anywhere between 1 Litre to 1.5 Liters of water throughout the day.... for the last almost 5 years....

(Sunshade: you keep saying I'm over weight, I eat too much, you cut my food portion down. I bet you anything, I'm made up of ALLLLLLLLL water!HMMMMMMPH!)

Sunshade really is a good girl. I by no mean "forced" her to drink, not even by syringe. I started out by making her broth, and gave her full strength broth while adding in a command like "GET WATER" while she was drinking. She associated the drinking action with the command. Then I started to mix half broth half water, slowly cutting down the broth while upping the water. Used the same command, and she learned from drinking that "GET WATER" meant to finish the bowl of broth/water put in front of her. So now she knows the command even when I give her plain water.

I do get that "I'm really NOT thirsty!" look from her a lot of the times, but if I tell her to, she will finish up the bowl for me. This is the dogter that would walk through fire for me. My fully hydrated, Perfect Sunshade!

Anyway, so this is what I've been doing for Sunshade and Jaffa. Jaffa has not shown signs of any acid reflux problems, and he is not anemic, so I haven't had to give him those meds yet. Hopefully, he really is only in acute renal failure, and his blood work will return to normal by the next testing....

Saturday, December 1, 2007

Hi everyone, thank you for continuing to check back to the blogs and offering support for me, and my Aire-kids. Those who have e-mailed me privately, thank you, I will respond to all of you soon.

The good news is, I'm done sulking and feeling sorry for myself, Sunshade and most importantly, Jaffa. Jaffa is not feeling sorry for himself, so I shouldn't be either. It must be all the positive energy, Aire-Zens, prayers sent by caring folks from all over the world that have kept Jaffa feeling SOOOOO great despite his blood work! He really appears completely NORMAL. Sunshade is very in tuned with my emotions, and she has been counting on me to cheer up so she can cheer up herself too. That's exactly what I'll be doing for my special girl!

The shock, and denial stage is over. I'm not going to dwell on the unfortunate event that has happened, instead, I'm focusing my energy on how to make the best of things given the situation I'm in. I want to do everything in my power to give Jaffa the best quality of life for as long as possible. Same goes for Sunshade.

In the last couple of days, I've been talking to some folks on the Yahoo K9KIDNEY and K9KidneyDiet groups. I don't think Miss Sunshade has ever mentioned this before, but she too has kidney insufficiency. Back in 2003 when Sunshade was 3.5 years old, an abdominal ultrasound intended for her pancreas showed she had scarring of both kidneys. The exact cause of the scarring is unknown, but we suspect it's due to NSAID (Non-Steroidal Anti-Inflammatory Drugs) toxicity. Sunshade was prescribed very high doses of NSAID's for her joint problems over a long period of time when she was young; before I knew anything about dog health/natural therapies. In Sunshade's case, her blood work was *never* out of the normal range. Meaning, she didn't have 100% kidney function, but she had more than 25% function which was all you need to lead a normal life. If we hadn't done the ultrasound, I still would not have known about her kidney condition even 'til today.

I joined the two kidney groups mentioned above when I first found out about Sunshade's kidneys back in 2003. I lurked the group and learned about managing kidney disease through diet modification, medication, supplementation, and daily Sub-Q fluid administration. The reason I did all that was to prepare myself so that if heaven forbid one day, Sunshade went into Chronic Kidney Failure, I would know how to manage it. Luckily, FIVE years later, Sunshade's bi-annual blood works have been nothing but perfect. Other than having her on some renal supportive supplements, I haven't had to do much.

Jaffa always calls Sunshade, "his" Sunshade, because in a way, she is always watching out for him.

Because of his Sunshade, I am able to quickly formulate a raw diet that is easier on his kidneys. He has also been put on all of Sunshade's renal support supplements since day one. Because of his Sunshade, I am not overwhelmed (after the initial shock stage that is) with what is needed to be done to keep him feeling well for as long as possible.

After talking to the very knowledgeable groups of people on K9KIDNEYS/K9KidneyDiets, I have decided to start giving him Sub-Q fluids at home everyday. Sub-Q fluids go under the skin instead of into the vein like IV's do. It keeps the dog hydrated while flushing and helping to take the load off those kidneys. He is also being fed a diet that is low in phosphorous (most harmful nutrient for failing kidneys) at around 11-15 mg of phos per pound of body weight per day. Those are very strict protocols usually used for dogs in "late stage" kidney failure.

However, some felt Jaffa's ibuprofen ingestion is still considered an acute assult. Which means, he is in "acute renal failure" and there is a chance that his serum kidney numbers can go down to the normal range. They suggested I treat him as aggressively as possible for NOW, baby those kidneys, and give them all the support I can possibly provide with diet and hydration.

Sunshade's kidneys suffered an assault, but whatever damage was done, was done and the kidneys have not worsened. Sure she doesn't have 100% kidney function, but she only needs 25% kidney function to live a healthy, normal life span (that's why kidney donors can live on 50% kidney function). This, is what I'm hoping for Jaffa as well. Whatever permanent damage he has suffered or will have suffered from the ibuprofen toxicity will leave him with > 25% kidney function (blood work in normal range).

I am hoping against all odds that I'll end up with two very expensive dogs to upkeep, but neither in Chronic Renal Failure......

Janice suggested we not do another blood test until Dec. 20th, which marks the one month anniversary of ibuprofen ingestion. I think she sensed the increase in my stress level with each blood work LOL. Meanwhile, we will continue with all the kidney supportive care and treat Jaffa as if he were a "late stage" renal failure patient.

Feedjit

About Jaffa

Jaffa - Vancouver, British Columbia

Me is Jaffa. I am Miss Sunshade's biological nephew, but I call her MY Sunshade! Me me is 3 years old now. Me still young, can't write write that much yet. I like like to bite bite on Sunshade's face and mummy's nose and peeple fingers. I love loooove MY Sunshade a lot a lot. I hope I can be as good good of an Airedale as Sunshade, so me learn learn a lot lot from Sunshade.

About Stella

My name is Princess Stella! You can call me Stella for short if you want. Jaffa is my brother but I don't live with him because umm... a princess like me needs to rule her own castle you know what I mean?? I still get to see Jaffa and Aunty Sunshade a lot, so I get like..the best of both worlds!! So now I live with the KOOKIE family!! I think I'm like the luckiest and happiest princess alive!!